Common use of Member Services Clause in Contracts

Member Services. a. Instructions on how to contact the Member Services Call Center and a description of the functions of Member Services; b. A description of availability of and instructions on how to access clinical personnel who act within the scope of their licensure to practice medical and behavioral health-related profession twenty-four (24) hours, seven (7) days per week; c. A description of availability of and instructions on how to utilize the twenty- four (24) hours, seven (7) days per week nurse advice line; d. A description of EPSDT screenings and services and instructions advising Members about how to access such services; e. A description of all available covered services, including inpatient services, behavioral health/substance use disorder, Non-Emergency Transportation, dental, maternity, pharmacy, and preventive services, services available to children in ▇▇▇▇▇▇ care, if applicable, and an explanation of any service limitations, referral and Prior Authorization requirements. This description should include that the Member may receive a minimum of a three (3)-day emergency supply for prior authorized drugs until authorization is completed; f. Information about the features of Care Management, the responsibilities of the Contractor for coordination of Member care, and the Member’s role in the Care Management process; g. Procedures for notifying Members of the termination or change in any benefits, services, or locations; h. A description of the enhanced services the Contractor offers, if applicable; i. A description of the Contractor’s confidentiality policies; j. An explanation of any service limitations or exclusions from coverage; including limitations that may apply to services obtained from Out-of-network Providers; k. A notice stating that the Member shall be liable only for those services subject to Prior Authorization and not authorized by the Contractor and non-covered services; l. Circumstances under which an eligible Member may disenroll or be involuntarily disenrolled from the Contractor and/or MississippiCAN Program;